Peter R. Hunt, BDS, MSc, LDSRCS Eng

Disclosures

November 16, 2011

Presentation: Partial Anodontia and Old Bridgework

A woman in her late 30s presented for routine dental care. Twenty years before this visit, traditional bridgework had been used to replace congenitally missing maxillary lateral incisors. She complained that her smile was not aesthetic. The pontics replacing the incisors appeared to be suspended in space as a result of resorption of the underlying ridge. The gingival graft on the patient's maxillary right canine was bulky and appeared highly unnatural. On the contralateral canine, recession was present, and the soft tissue complex was very thin. Attrition, mild enamel dysplasia, and underlying tetracycline-staining characterized her remaining dentition (Figure 1).

Figure 1. Preoperative photo.

Dental Therapy

The patient's bridge was removed and replaced with an acrylic provisional bridge to facilitate the necessary surgical procedures. All procedures were combined in a single operation.

The hypertrophic gingival graft on the maxillary right canine was excised and a lateral periodontal flap, extending to the second molar, was swung forward to cover the 3.8 mm x 13 mm root form implants with gingivaformers that protruded transgingivally and were placed in the lateral incisor regions using an open-flap crestal approach. Concurrently, subepithelial connective tissue grafts taken from the palatal flap were placed to plump out the soft tissue on the labial aspect of the implant sites. The marginal tissue around the maxillary left canine was augmented with a subepithelial connective tissue graft.

Following a healing period of 3 months, during which the provisional bridge was in place, the preparations on the natural teeth were refined and extended slightly subgingivally. Individual impressions of the tooth preparations were recorded, with copings fabricated in the dental laboratory. At a later session, these copings were fitted to the teeth. Then, an overall master impression replicated the copings and the registration for the implants, using 3.8 mm closed tray impression devices. This allowed a master model to be made with implant analogs in the position of the dental implants. Two abutments for the implants were developed from oversized titanium components. These were inserted to ensure proper fit (Figure 2).

Figure 2. Try-in of titanium abutments postoperatively.Individual crowns were made to fit the implant abutments and the natural teeth.

Patient Outcome

The final restorations were placed 6 months after therapy was started (Figure 3). The result has been stable since placement. The patient reports that she looks and feels great.

Figure 3. Final result showing individual all-ceramic restorations.

Comments

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